Abstract
INTRODUCTION: The population-based rate of motor vehicle crash mortality is consistently higher in rural locations, but it is unclear how much of this disparity might be due to geographic barriers or deficiencies in emergency medical services (EMS). We sought to analyze separately factors associated with the occurrence of a severe injury and those associated with death after injury had occurred. METHODS: Data from all police-reported crashes in 11 states from 2005-2007 were obtained through the National Highway Traffic Safety Administration (NHTSA) State Data System (SDS). Logistic regression was used to estimate factors associated with (1) death; (2) severe (incapacitating or fatal) injury; and (3) death given severe injury. Models included covariates related to the person, vehicle, and event; county location was specified using Rural-Urban Continuum Codes (RUCC). RESULTS: Older age, not wearing a belt, ejection, alcohol involvement, high speed, and early morning times were associated with increased risk of both severe injury and death. Controlling for these factors, and restricting analysis to persons who had suffered a severe injury, the adjusted odds ratio (aOR) associated with death was higher for counties classified rural (RUCC 6-7, aOR 1.23, 95% CI 1.16-1.31) or very rural (RUCC 8-9, aOR 1.31, 95% CI 1.18-1.46). CONCLUSIONS: Persons severely injured in crashes are more likely to die if they are in rural locations, possibly due to EMS constraints. As NHTSA-SDS data become more available and more uniform, they may be useful to explore specific factors contributing to this increased risk.